More threads by gophergirl

I have an unusual presentation of OCD which affects the psychological processes of writing complex material (the OCD thought patterns seems to affect each cognitive level of the written composition process, making it difficult to treat). Anyway, over the years, I have been with a very good psychologist who has allowed me to incorporate stuff from my own professional field of expertise (which is learning difficulties) in order to deal with it. Since not much has directly been written in the literature on the subject, we have effectively been developing strategies as we go along, necessitating a somewhat longer than usual therapeutic relationship (about 12 years). We have managed to develop exemplary rapport, a good bond, and now work more as collaborators in sessions. We get on extremely well, and click personally.

He has been away on sabbatical for some months and I was supposed to contact him when he got back about sessions, which I dutifully did, and I asked straight out was he able to retake me on as client. I received an email response several days later indicating that he was needing to close his clinical practice because with his academic research, he was finding it too difficult to fit in clinical work. I know this is the case, because he really has been struggling with a huge workload from his department - he has become increasingly tired to where he began looking permanently jetlagged as a result. He then suggested an appointment to catch up and discuss it - in effect, the termination session.

I replied by email words to the effect - OK, when? No reply for several days. So I bit the bullet and rang him (actually got him on the mobile phone whilst he was driving to the airport for another conference). He sounded extremely pleased to hear from me, and yes, he would email me in a couple of days with an appointment time. Some 10 days go by and no email. So I wrote another email reminding him. I'm still waiting to hear back (I only did it today so it's too early to tell), but I'm betting that I won't get a response to that either. It's almost like I've got to catch him on the spot where he has his PDA, not driving, not in the middle of a meeting, and no way of wriggling away to get this set up.

You usually have to chase him a bit with regard to administrative or paperwork stuff, because he doesn't really like that stuff much (and it's not his forte), but with regards to appointments, he's usually pretty quick. He did indicate in his original email that the decision to concentrate on research alone and not do any clinical work has been a difficult one for him, and that he finds it particularly hard when it comes to finishing with long term clients like myself. There is always a workload based excuse (had to get a grant off, etc), but checking his PDA and dashing off an email is a 5 minute exercise. I'm beginning to feel like he's avoiding this session, and by extension that he's avoiding me - although at the moment, I've been experiencing some traditional OCD doubting thoughts that have led me to resume Prozac to get back to the stage where I can successfully implement all the CBT principles I've learned. So I don't know whether I'm just experiencing OCD type thought patterns at this stage, or whether there is some genuine avoidance there. I think I'm the last client left that he has to terminate, but I'm not sure, so there may be some finality issues there for him. Being really chirpy on the phone made it even more confusing to me because on one hand he's so cheerful it's like he hasn't heard from me for 8 years instead of 8 months, and on the other, he seems to have every excuse to avoid replying with a termination session date, and I just don't want to have to keep chasing and chasing and chasing to get a date set hearing, 'sorry, I've been so disorganised, I'll get back to you in x days' or whatever. We've had a really good relationship, so I wouldn't expect that this would be something ghastly and horrible, although obviously a bit sad, because we've got along so well (similar working methods, approaches, interests, etc - I hesitate to say friends because of the ethical implications, but certainly there is a friendly and very real bond there.)

So in the meantime, without any of the sort of communication which would allow me to correctly discern where he is coming from with this, I have no idea whether he is regarding this impending session as the clinical equivalent of getting a dentist perform a root canal, whether he is just too wrapped up in research to be 'in the zone' clinically, whether he doesn't want to face me in particular or what. As someone with OCD, I can usually recognise avoidance; like many OCD sufferers you could say that I wrote the book on avoidance strategies, and as a specialist teacher myself, I'm used to ferretting it out in one on one sessions with learning disabled and helping them deal wth it. I don't even know whether it might be guilt pangs for pretty much dropping me in it all of a sudden (however, I've spent several years under the guidance of these sessions accumulating all the relevant psychology literature I can, and even writing postgraduate papers on it myself in my own department under prominent educational psychologists, so it can be safely said that I have a plan of action for myself post-therapy with this guy.

My own original email reply to his was understanding and sympathetic (I've actually gone out of my way to try to make it a less difficult experience for him), and he even commented on it being a beautiful email (right before I never end up with a scheduled appointment). The appointment was his idea; I concur with him that it is the correct professional way to handle termination in this case. But this continual non-contact is confusing, as well as making me feel like I'm something dreadful that can't be faced. He has been busier than this and still managed. It also feels somewhat hurtful because it feels disrespectful, although I don't know whether this is intentional or something he just doesn't even realise is likely to have this effect. Unpleasant as it is to terminate with someone you connect with well, it can't be dragged out indefinitely, and I need to do a lot of planning for my own OCD management over the next few months, which I will be tending to take the largest share of managing from this point, given my own area of speciality (adapting CBT into research on cognition and learning to develop instructional strategies I can adopt). I can usually talk to him of most things, but I'm beginning to think that I can't talk to him about this because he might just clam up even worse. I've gone through cycles of hurt, anger, and indignation - not to do with the termination of the therapy itself, but rather his attitude towards getting the deed done, as it just seems to be very low down on his priority list. And that is even worse - like maybe my needs for therapy to close well are not so important anymore. Again, this is my own interpretation; lack of communication on the issue tends to make it difficult to come to an informed interpretation of these actions.

So any ideas given the above situation? How would you best interpret this sort of behaviour from a soon to be ex-therapist? I know that for him there is at least some emotional investment in working as a clinical psychologist because he has always done it, and not it's just nothing but research papers for him. But I'm 100% baffled by his behaviour. Any suggestions for trying to work out his rationale in all this?
my thought is that without speaking to him it is all going to be a lot of speculation. i think you need to somehow catch up with him in person to set that date, and then discuss this at the set appointment. is there any way for you to drop by his office, or catch him somewhere else where you know he'll be?

i am thinking you may need more than just one appointment for terminating. if it were me i would like to have maybe a few, where in the first one you discuss what's been going on, just so you're not left with a bunch of questions and having this unresolved and end up wondering about it for a long time to come. then once that is worked out, go to the matter at hand and have the final one or two termination sessions.

Daniel E.
It does seem like the primary issue is that he is very busy. I remember trying to setup an appointment to get a second opinion from an OCD expert/researcher who only did a small percentage of clinical work. If I remember correctly, he had to cancel the appointment, and I just called back his secretary every few weeks until he was finally able to reschedule to give me an evaluation.
His busy-ness is the reason that our sessions have to come to an end, in fact. But it had been unlike him to take so long for an appointment (a 24-hour turn around usually) - although, anything to do with paperwork, you'd have to chase forever.

He did in fact reply this morning and we have an appointment set up for Thursday, so I should be able to ask whatever questions I need to then. For some quirky reason, they are more likely to get answered if I add the word 'Nagmail' in the email subject heading :) (So this time added a humorous 'exploding nagmail' a la Harry Potter....)

I can't see a gradual tapering happening due to the reason for his shutting up shop. He really can't sustain both his academic committments and his clinical work at this point, even if he wanted to (which I think he really does want to, and finds it hard to have to make this decision). From my own perspective, I'd find it a bit hard to do it that way, for the simple reason that we have known each other so long and I have improved so much that the working relationship has become much more like equal collaborators than a power differential, and almost friend-like (and I hesitate to say that because I'm aware of the ethics involved). I would find it harder than simply making a break.

In fact, that was the other problem for me - that I don't mind a new direction in therapy (the focus in fact has shifted less from clinical psychology anyway now that I've got a decent handle on CBT techniques to more that of educational psychology - applying and adapting it in areas where OCD is affecting the underlying information processing involved in completing postgrad academic work). But it would have been a bit hurtful had I been avoided on the termination issue, because of the exemplary working relationship up to that point, and because I've been doing my very best to make the situation as easy as possible for him as well as for myself.

I've resumed Prozac, and although it will be a long time until it's fully in my system, I traditionally find that I get the initial effects much more quickly than usually described in the literature. I'm wavering a lot less on this point consequently than I was even a couple of days ago. There are still some questions I need to ask, however; I can only hope that he will answer them satisfactorily. I may have to be honest about how I felt about the lack of reply - tactfully and respectfully - and see what the response is.


I am glad that he finally got back to you and that have an appointment on Thursday.

What may help in preparation for your appointment is to make a list of the questions that you have beforehand so that when you leave you will not have forgotten anything.
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